经云。寒气客于皮肤。阴气盛。阳气虚。故为振寒寒栗。深师曰。振乃阴气争胜。故为战。
栗则阳气不复。故为颤。骨者髓之府。不能久立。行则振掉。骨将惫矣。颤振与螈 相类。螈
则手足牵引。而或伸或屈。颤振则但振动而不屈也。亦有头动而手不动者。盖木盛则生风生火。
上冲于头。故头为颤振。若散于四末。则手足动而头不动也。经曰。诸风掉眩。皆属于肝。若肝
木实热。泻青丸。肝木虚热。六味丸。肝木虚弱。逍遥散加参、术、钩藤。挟痰。导痰汤加竹沥。
脾胃虚弱。六君子汤加芎、归、钩藤。卫虚多汗恶寒。加黄 二钱。附子五分。脾虚。补中益气
加钩藤。心血虚少而振。平补正心丹。心气虚热而振。本方去肉桂、山药、麦冬、五味。加琥珀、
牛黄、黄连。名琥珀养心丹。心虚挟痰而振。本方去龙齿、肉桂、山药、麦冬、五味。加琥珀、
川芎、胆星、麝香、甘草。为秘方补心丹。心虚挟血而振。龙齿清魂散。肾虚而行步振掉者。八
味丸、十补丸选用。实热积滞。可用汗吐下法。戴人治马叟。手足振掉。若线提傀儡。用涌法。
出痰数升而愈。此必痰证痰脉。而壮盛气实者。不可不知。
〔诊〕颤振之脉。小弱缓滑者可治。虚大急疾者不治。间有沉伏涩难者。必痰湿结滞于中之象。
凡久病脉虚。宜于温补。暴病脉实。宜于峻攻。若久病而脉反实大。暴病而脉反虚弱。决无收功
之理也。
《黄帝内经》说：寒气侵入皮肤，阴气偏盛，阳气虚弱，所以出现怕冷发抖、寒战的症状。深师（指古代医家）说：振栗是因为阴气与正气相争胜，所以表现为战栗；栗动是因为阳气不能恢复，所以表现为颤抖。骨是髓的居所，如果骨头功能衰退，就不能久站，走路时身体会摇晃不定，这是骨骼即将衰败的表现。颤振与抽搐症状相似，抽搐表现为手足牵引拘急，时而伸展时而弯曲；而颤振只是肢体振动，并不伴随屈伸动作。也有只有头部抖动而手不抖动的情况。这是因为肝木之气过盛则生风生火，火热之邪上冲头部，导致头部颤振；如果风气散在于四肢末端，则表现为手足动摇而头部不动。《内经》说：各种风病引起的摇动眩晕，都归属于肝脏。如果是肝木实热证，使用泻青丸治疗；肝木虚热证，使用六味丸治疗；肝木虚弱证，使用逍遥散加入人参、白术、钩藤；兼有痰湿者，使用导痰汤加入竹沥；脾胃虚弱者，使用六君子汤加入川芎、当归、钩藤；卫气虚弱、多汗且恶寒者，在原方基础上加黄芪二钱、附子五分；脾气虚弱者，使用补中益气汤加入钩藤；心血不足导致的震颤，使用平补正心丹；心气虚伴有内热导致的震颤，在本方基础上去掉肉桂、山药、麦冬、五味子，加入琥珀、牛黄、黄连，命名为琥珀养心丹；心虚兼夹痰浊导致的震颤，在本方基础上去掉龙齿、肉桂、山药、麦冬、五味子，加入琥珀、川芎、胆南星、麝香、甘草，称为秘方补心丹；心虚兼夹血瘀导致的震颤，使用龙齿清魂散；肾虚导致行走时摇晃不稳者，选用八味丸或十补丸。若是实热积滞所致，可以使用汗法、吐法或下法治疗。戴人（张从正）曾治疗马叟，患者手足震颤，像被线提着的木偶一样，采用涌吐法，吐出数升痰液后痊愈。这必定是痰证且有痰脉表现，且患者体质壮实气盛的情况，这一点不可不知。
【诊法】颤振病的脉象，小弱缓滑的是可治之症；虚大急疾的是难治或不治之症。间或有沉伏涩难的脉象，这是痰湿凝结阻滞于体内的征象。凡是久病脉象虚弱的，适宜用温补法；突发疾病脉象实的，适宜用峻猛攻伐法。如果久病脉象反而实大，或者暴病脉象反而虚弱，肯定没有治愈的道理。
The *Classic of Medicine* (*Huangdi Neijing*) states: "When cold pathogenic qi lodges in the skin, yin qi becomes excessive while yang qi is deficient, resulting in aversion to cold with shivering and tremors." Shen Shi (an ancient physician) stated: "Shivering occurs when yin qi contends and gains the upper hand, manifesting as rigors; trembling occurs when yang qi fails to recover, manifesting as tremors." The bones are the residence of marrow. If the bones are failing, one cannot stand for long, and walking causes shaking and instability, indicating that the skeletal system is deteriorating. Tremor and convulsion are similar conditions. Convulsion involves traction of the limbs, with extension or flexion alternating; whereas tremor involves only vibration without flexion or extension. There are cases where only the head moves while the hands remain still. This is because excessive Wood qi generates wind and fire, which rush upward to the head, causing head tremors. If the wind scatters to the four extremities, it causes movement of the hands and feet while the head remains still. The *Classic* states: "All wind diseases characterized by shaking and dizziness belong to the Liver." For Liver Wood excess-heat syndrome, use *Xieqing Wan* (Drain the Green Pill); for Liver Wood deficiency-heat syndrome, use *Liujun Wan* (Six-Ingredient Pill with Rehmannia); for Liver Wood deficiency, use *Xiaoyao San* (Free and Easy Wanderer Powder) added with Ginseng (*Renshen*), Atractylodes Macrocephala (*Baizhu*), and Uncaria (*Gouteng*); if complicated by phlegm, use *Daotan Tang* (Major Phlegm Decoction) added with Bamboo Juice (*Zhuli*); for Spleen-Stomach deficiency, use *Liujunzi Tang* (Six Gentlemen Decoction) added with Ligusticum (*Chuanxiong*), Angelica Sinensis (*Danggui*), and Uncaria (*Gouteng*); for Defensive Qi deficiency with profuse sweating and aversion to cold, add Astragalus (*Huangqi*) 2 qian and Aconite (*Fuzi*) 5 fen; for Spleen deficiency, use *Buzhong Yiqi Tang* (Tonify the Middle and Augment the Qi Decoction) added with Uncaria (*Gouteng*); for tremors due to Heart Blood deficiency, use *Pingbu Zhengxin Dan* (Leveling and Tonifying the Heart Pill); for tremors due to Heart Qi deficiency with heat, remove Cinnamon Twig (*Rougui*), Dioscorea (*Shanyao*), Ophiopogon (*Maidong*), and Schisandra (*Wuweizi*) from this formula, and add Amber (*Hupo*), Calculus Bovis (*Niuhuang*), and Coptis (*Huanglian*), naming it *Hupo Yangxin Dan* (Amber Nourishing Heart Pill); for tremors due to Heart deficiency complicated by phlegm, remove Dragon Bone (*Longgu*), Cinnamon Twig (*Rougui*), Dioscorea (*Shanyao*), Ophiopogon (*Maidong*), and Schisandra (*Wuweizi*) from this formula, and add Amber (*Hupo*), Ligusticum (*Chuanxiong*), Arisaema with Bile (*Danning*), Musk (*Shexiang*), and Licorice (*Gancao*), calling it *Mifang Buxin Dan* (Secret Recipe Tonifying Heart Pill); for tremors due to Heart deficiency complicated by blood stasis, use *Longqing Qinghun San* (Dragon Bone Clearing Soul Powder); for tremors during walking due to Kidney deficiency, select *Bawei Wan* (Eight-Ingredient Pill) or *Shibu Wan* (Ten-Nourishing Pill). If caused by excess-heat and accumulation stagnation, diaphoretic, emetic, or purgative methods may be used. Dairen (Zhang Congzheng) treated an old man named Ma, whose hands and feet trembled like a puppet on strings. He employed the emetic method, expelling several sheng of phlegm, after which the patient recovered. This situation must involve phlegm signs and phlegm pulses, occurring in individuals with robust constitution and strong qi; this point must not be overlooked.
[Diagnosis] Regarding the pulse of tremor: a small, weak, slow, and slippery pulse indicates a treatable condition; a deficient, large, rapid, and hurried pulse indicates an untreatable condition. Occasionally, a deep, hidden, and choppy pulse may appear, which is a sign of phlegm-dampness congealing and obstructing internally. For chronic diseases with a deficient pulse, warm tonification is appropriate; for acute diseases with an excess pulse, vigorous attacking methods are appropriate. If a chronic disease presents with an unexpectedly excess-large pulse, or an acute disease presents with an unexpectedly deficient pulse, there is no hope for recovery.